Title 31A, Title 31A: Insurance Code

31A-22-511. Dependents' coverage. (1) A group life policy issued under Sectionsthroughor Sectionmay insure any class of employee or member and the spouse and dependent children of an employee or member against loss due to death. 31A-22-502 31A-22-505 31A-22-509 (2) The policyhold…

31A-22-512. Individual insurability. (1) An insurer may exclude or limit the coverage under a group life insurance policy on any person, including a group member's dependent, as to whom the evidence of individual insurability is not satisfactory to the insurer. (2) The group life…

31A-22-513. Grace period. (1) Every group life insurance policy shall contain a provision that the policyholder is entitled to a grace period of not less than 31 days for the payment of any premium due except the first payment of premium. During the grace period described in Subs…

31A-22-514. Incontestability. (1) A group life insurance policy shall contain a provision that the validity of the policy may not be contested, except for nonpayment of premiums, after the policy has been in force for two years from its date of issue. (2) The provision described …

31A-22-515. Nonforfeiture. If the group life insurance policy is not a term policy, it shall contain nonforfeiture provisions which the commissioner determines to be equitable to the insured persons and to the policyholder. The commissioner may not require that group life insuran…

31A-22-516. Payment of benefits. Any sum which is due because of the death of the person insured is payable to the beneficiary designated by the insured person, unless the policy contains conditions providing that the beneficiary is a family member designated by the policy terms.…

31A-22-517. Conversion on termination of eligibility. (1) Except as provided in Subsection, a person is entitled to be issued by an insurer, without evidence of insurability, an individual policy offering life insurance without accident and health or other supplementary benefits,…

31A-22-518. Conversion on termination of policy. (1) Subject to Subsection, if the group policy terminates or is amended to terminate the insurance of any class of covered persons, every insured person whose insurance terminates, including the insured dependent of a covered perso…

31A-22-519. Death pending conversion. If a person insured under a group life insurance policy, or the insured dependent of that person, dies during the period of eligibility for conversion under Sectionorand before the individual policy becomes effective, the amount of life insur…

31A-22-520. Continuation of coverage during total disability. (1) An insured person in a group life insurance policy may continue coverage during the total disability of the insured person or dependent by timely payment to the policyholder of that portion, if any, of the premium …

31A-22-521. Notice of right to convert under group policy. Certificates of insurance evidencing coverage under a group life insurance policy shall prominently notify individuals of conversion rights and contain information concerning the time and manner in which conversion to an …

31A-22-522. Required provision for notice of termination. (1) A group insurance policy offering life insurance coverage or a blanket insurance policy offering life insurance coverage shall include a provision that obligates the policyholder to notify each employee or group member…

31A-22-600. Scope of Part 6. (1) Except where a provision's application is otherwise specifically limited, this part applies to all: accident and health insurance contracts, including credit accident and health; franchise; group contracts; and life insurance and annuity policies …

31A-22-601. Applicability of life insurance provisions. Sectionsthroughapply to death benefits in accident and health insurance policies.

31A-22-602. Premium rates. (1) Except as provided in Subsection, this section does not apply to group accident and health insurance. 31A-22-701(4) (2) The benefits in an accident and health insurance policy shall be reasonable in relation to the premiums charged. (3) The commissi…

31A-22-603. Persons insured under an individual accident and health policy. A policy of individual accident and health insurance may insure only one person, except that originally or by subsequent amendment, upon the application of an adult policyholder, a policy may insure any t…

31A-22-604. Reimbursement by insurers of Medicaid benefits. (1) As used in this section, "Medicaid" means the program under Title XIX of the federal Social Security Act. (2) Any accident and health insurer, including a group accident and health insurance plan, as defined in Secti…

31A-22-605. Accident and health insurance standards. (1) The purposes of this section include: reasonable standardization and simplification of terms and coverages of individual and franchise accident and health insurance policies, including accident and health insurance contract…

31A-22-605.1. Preexisting condition limitations. (1) Any provision dealing with preexisting conditions shall be consistent with this section, Section, and rules adopted by the commissioner. 31A-22-609 (2) Except as provided in this section, an insurer that elects to use an applic…

31A-22-605.5. Application. (1) For purposes of this section "insurance mandate": means a mandatory obligation with respect to coverage, benefits, or the number or types of providers imposed on policies of accident and health insurance; and does not mean: an administrative rule im…

31A-22-606. Policy examination period. (1) Except as provided in Subsection, all accident and health policies shall contain a notice prominently printed on or attached to the cover or front page stating that the policyholder has the right to return the policy for any reason withi…

31A-22-607. Grace period. (1) An individual or franchise accident and health insurance policy shall contain one or more clauses providing for a grace period for premium payment only of: at least 15 days for a weekly or monthly premium policy; and 30 days for a policy that is not …

31A-22-608. Reinstatement of individual or franchise accident and health insurance policies. (1) Every individual or franchise accident and health insurance policy shall contain a provision which reads substantially as follows:"REINSTATEMENT: If any renewal premium is not paid wi…

31A-22-609. Incontestability for accident and health insurance. (1) A statement made by an applicant relating to the person's insurability, except fraudulent misrepresentation, may not be a basis for avoidance of a policy, coverage, or denial of a claim for loss incurred or disab…

31A-22-610. Dependent coverage from moment of birth or adoption. (1) As used in this section: "Child" means, in connection with any adoption, or placement for adoption of the child, an individual who is younger than 18 years old as of the date of the adoption or placement for ado…

31A-22-610.1. Indemnity benefit for adoption or infertility treatments. (1) If an insured has coverage for maternity benefits on the date of an adoptive placement, the insured's policy shall provide an adoption indemnity benefit payable to the insured, if a child is placed for ad…

31A-22-610.2. Maternity stay minimum limits. (1) If an insured has coverage for maternity benefits, the policy may not be limited to a less than a 48-hour benefit for both mother and newborn with a normal vaginal delivery. If an insured has coverage for maternity benefits, the po…

31A-22-610.5. Dependent coverage. (1) As used in this section, "child" means the same as that term is defined in Section. 81-6-101 (2) Any individual or group accident and health insurance policy or managed care organization contract that provides coverage for a policyholder's or…

31A-22-610.6. Special enrollment for individuals receiving premium assistance. (1) As used in this section: "Premium assistance" means assistance under, in the payment of premium. Title 26B, Chapter 3, Health Care - Administration and Assistance "Qualified beneficiary" means an i…

31A-22-611. Coverage for children with a disability. (1) For the purposes of this section: "Dependent with a disability" means a child who is and continues to be both: unable to engage in substantial gainful employment to the degree that the child can achieve economic independenc…

31A-22-612. Conversion privileges for insured former spouse. (1) An accident and health insurance policy, that in addition to covering the insured also provides coverage to the spouse of the insured, may not contain a provision for termination of coverage of a spouse covered unde…

31A-22-613. Permitted provisions for accident and health insurance policies. The following provisions may be contained in an accident and health insurance policy, but if they are in that policy, they shall conform to at least the minimum requirements for the policyholder in this …

31A-22-613.5. Price and value comparisons of health insurance. (1) This section applies to all health benefit plans. Subsectionapplies to: (2) all health benefit plans; and coverage offered to state employees under Subsection. 49-20-202(1)(a) (2) The commissioner shall promote in…

31A-22-614. Claims under accident and health policies. (1) Sectionapplies generally to claims under accident and health policies. 31A-21-312 (2) Subject to Subsection (1), an accident and health insurance policy may not contain a claim notice requirement less favorable to the ins…

31A-22-614.5. Uniform claims processing -- Electronic exchange of health information. (1) Except as provided in Subsection, an insurer offering health insurance shall use a uniform claim form and uniform billing and claim codes. (1)(c) Beginning January 1, 2011, all health benefi…

31A-22-614.7. Uniform claims processing -- Electronic exchange of prescription drug pre-authorization. The commissioner shall consult with national and state organizations involved with the standardized exchange of health data, and the electronic exchange of health data, to study…

31A-22-618. Nondiscrimination among health care professionals. (1) Except as provided under Sectionand Subsection, and except as to insurers licensed under, no insurer may unfairly discriminate against any licensed class of health care providers by structuring contract exclusions…

31A-22-618.5. Coverage of insurance mandates imposed after January 1, 2009. (1) The purpose of this section is to increase the range of health benefit plans available in the small group, small employer group, large group, and individual insurance markets. (2) A health maintenance…

31A-22-618.6. Discontinuance, nonrenewal, or changes to group health benefit plans. (1) Except as otherwise provided in this section, a group health benefit plan for a plan sponsor is renewable and continues in force: with respect to all eligible employees and dependents; and at …

31A-22-618.7. Discontinuance, nonrenewal, and modification for individual health benefit plans. (1) Except as otherwise provided in this section, a health benefit plan offered on an individual basis is renewable and continues in force: with respect to all enrollees or dependents;…

31A-22-618.8. Discontinuance and nonrenewal limitations for health benefit plans. (1) Subject to Section, an insurer that elects to discontinue offering a health benefit plan under Subsectionoris prohibited from writing new business: 31A-4-115 31A-22-618.6(5)(e) 31A-22-618.7(3)(e…

31A-22-619. Coordination of benefits. (1) The commissioner shall: adopt rules concerning the coordination of benefits between accident and health insurance policies; publish a coordination of benefits guide; post the coordination of benefits guide on the state insurance exchange;…

31A-22-620. Medicare Supplement Insurance Minimum Standards Act. (1) As used in this section: "Applicant" means: in the case of an individual Medicare supplement insurance policy, the person who seeks to contract for insurance benefits; and in the case of a group Medicare supplem…

31A-22-623. Coverage of inborn metabolic errors. (1) As used in this section: "Dietary products" means medical food or a low protein modified food product that: is specifically formulated to treat inborn errors of amino acid or urea cycle metabolism; is not a natural food that is…

31A-22-624. Primary care physician, physician assistant, or physical therapist. (1) An accident and health insurance policy that requires an insured to select a primary care provider or physician to receive optimum coverage shall permit an insured to select a participating provid…

31A-22-624. Primary care physician, physician assistant, or physical therapist. (1) An accident and health insurance policy that requires an insured to select a primary care provider or physician to receive optimum coverage shall permit an insured to select a participating provid…